Improved in-hospital mortality in women undergoing coronary artery bypass grafting

O'Rourke, Daniel J.; Malenka, David J.; Olmstead, Elaine M.; Quinton, Hebe B.; Sanders, John H.; Lahey, Stephen J.; Norotsky, Mitchell; Quinn, Reed D.; Baribeau, Yvon R.; Hernandez, Felix; Fillinger, Mary P.; O’Connor, Gerald T.

doi:10.1016/s0003-4975(00)02236-0

Cited by 50 publications

(43 citation statements)

References 15 publications

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“…In contrast, in our study, women had fewer diseased vessels, as has been noted in several previous studies. 8,9,33,39,40 In addition, severity characteristics at presentation and severity of coronary artery disease only partially explained outcome differences at 6 months in our study.…”

Section: Why Do Women Fare Worse Than Men After Cabg?mentioning

confidence: 51%

Sex differences in health status after coronary artery bypass surgery

Vaccarino¹,

Lin²,

Kasl³

2004

ACC Current Journal Review

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Background-Although previous studies have shown functional improvements in patients who undergo coronary artery bypass graft (CABG) surgery, data are conflicting on whether the gains achieved by women are similar to or less than those achieved by men. Methods and Results-We compared physical and psychological functional gains and readmission rates between 777 men and 295 women who underwent first CABG consecutively between February 1999 and February 2001. Physical function and mental health were measured by means of the Short Form 36-Item Health Survey (SF-36). At 6 months, both men and women showed, on average, a significant improvement in physical function and mental health, but men improved significantly more than women. After adjustment for baseline characteristics, the mean score improvement in women was half that of men for physical function (7.3 versus 14.0, Pϭ0.0002) and 25% less than that of men for mental health (Ϫ3.0 versus 8.9, Pϭ0.026). The absolute rates of adverse outcomes, such as hospital readmission, worsening functional status, and worsening mental health, were significantly higher in women (32.6%, 25.7%, and 17.5%, respectively) than in men (21.2%, 11.1%, and 12.6%, respectively) and remained significantly different in multivariable analysis. Conclusions-CABG surgery is associated with lower functional gains and higher readmission rates in women compared with men 6 months after operation.

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Section: Why Do Women Fare Worse Than Men After Cabg?mentioning

confidence: 51%

Sex differences in health status after coronary artery bypass surgery

Vaccarino¹,

Lin²,

Kasl³

2004

ACC Current Journal Review

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“…6,8 -11,13,23 In contrast, other studies have continued to document a higher mortality in women that persisted in multivariable analysis. 12,14,16,24 However, these studies have typically not examined results stratified by age.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Hospital Mortality After Coronary Artery Bypass Surgery

et al. 2002

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Background-Data are conflicting over whether women have higher mortality than men after coronary artery bypass graft (CABG) surgery. Younger but not older women hospitalized for acute myocardial infarction have higher in-hospital mortality rates than men. We hypothesized that younger women also have higher in-hospital mortality rates after CABG. Methods and Results-We studied 51 187 patients (30% women) included in the National Cardiovascular Network database who received CABG at 23 clinical centers between October 1993 and December 1999. Compared with men, fewer women were white and more women had risk factors and comorbidities. These differences were more apparent in younger patients. In all age groups, however, women had higher left ventricular ejection fraction and fewer diseased vessels. Women had higher in-hospital mortality rates than men, but sex differences in mortality were more marked among younger patients. Women Ͻ50 years of age were 3 times more likely to die than men (3.4% versus 1.1%), and women 50 to 59 years of age were 2.4 times more likely to die than men (2.6% versus 1.1%). In the older age categories, the sex difference in in-hospital mortality was less marked (PϽ0.001 for the interaction between sex and age). Adjustment for preoperative risk factors only slightly decreased the strength of this interaction. Conclusions-Younger women undergoing CABG surgery are at a higher risk of in-hospital death than men, but this difference in risk decreases with advancing age. Additional investigation is needed to determine why in-hospital mortality is higher in women after CABG, with particular focus on younger women.

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“…424 It is important to note that mortality rates have fallen significantly over time, with a greater decrease in women than men. 425 Several theories have been advanced to explain the higher mortality in women, including older age, greater burden of comorbid disease and more urgent revascularization. However, women had better preserved left-ventricular function and less extensive coronary disease.…”

Section: -415mentioning

confidence: 99%

A comprehensive view of sex-specific issues related to cardiovascular disease

Pilote¹,

Dasgupta²,

Guru³

et al. 2007

Canadian Medical Association Journal

372

256

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A comprehensive view of sex-specific issues related to cardiovascular disease Cardiovascular disease (CVD) is the leading cause of mortality in women. In fact, CVD is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. The prevalence of CVD risk factor precursors is increasing in children. Retrospective analyses suggest that there are some clinically relevant differences between women and men in terms of prevalence, presentation, management and outcomes of the disease, but little is known about why CVD affects women and men differently. For instance, women with diabetes have a significantly higher CVD mortality rate than men with diabetes. Similarly, women with atrial fibrillation are at greater risk of stroke than men with atrial fibrillation. Historically, women have been underrepresented in clinical trials. The lack of good trial evidence concerning sex-specific outcomes has led to assumptions about CVD treatment in women, which in turn may have resulted in inadequate diagnoses and suboptimal management, greatly affecting outcomes. This knowledge gap may also explain why cardiovascular health in women is not improving as fast as that of men. Over the last decades, mortality rates in men have steadily declined, while those in women remained stable. It is also becoming increasingly evident that gender differences in cultural, behavioural, psychosocial and socioeconomic status are responsible, to various degrees, for the observed differences between women and men. However, the interaction between sex-and gender-related factors and CVD outcomes in women remains largely unknown. CMAJ 2007;176(6):S1-44 Although cardiovascular disease (CVD) is common, significant sex-related differences in its epidemiology have only recently been appreciated. The objective of this section is to demonstrate that there are sex-specific differences in the prevalence, complications and burden of CVD in terms of mortality, hospital admissions and quality of life. Abstract Search strategyA MEDLINE search was conducted using the MeSH terms "cardiovascular disease" OR "atrial fibrillation" OR "congestive heart failure." A second search used the terms "prevalence" OR "incidence" OR "mortality" and the final search combined the results of the first 2 searches and added the terms "gender" OR "sex." Articles identified in this manner were retrieved and their reference lists searched for additional relevant articles. The search was limited to English-language publications, but no other restrictions were applied. Other data sources included Web sites of the World Health Organization, the Canadian Institute for Health Information and the National Centre for Health Statistics. Thirty-three original studies were reviewed. Studies were included if they were cohort studies, case-control studies or nested cohort studies that examined the incidence, prevalence or mortality of CVD, congestive heart failure or atrial fibrillation. The studies had to include data on both ...

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Improved in-hospital mortality in women undergoing coronary artery bypass grafting

Cited by 50 publications

References 15 publications

Sex differences in health status after coronary artery bypass surgery

Sex differences in health status after coronary artery bypass surgery

Sex Differences in Hospital Mortality After Coronary Artery Bypass Surgery

A comprehensive view of sex-specific issues related to cardiovascular disease

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